Senior Medicare Compliance Advisor

Centene Corporation; Florida; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking an experienced Medicare Compliance Advisory specialist to support day-to-day execution of the program in alignment with CMS requirements. The role acts as a subject matter expert, translating regulations into actionable guidance for business stakeholders and supporting audit readiness across operations.

The position requires 5+ years in compliance or risk management in regulated environments, with 4+ years in compliance advisory, and familiarity with Medicare

Qualifications

• 5+ years Compliance, regulatory, operations, or risk management within a regulated industry.
• 4+ years Compliance advisory experience including regulatory research and drafting compliance guidance, risk tracking, auditing/monitoring, and correction action plans.
• 2+ years experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.
• Foundational knowledge of Medicare regulations, CMS guidance and compliance expectations.
• Strong written and verbal communication, analytical and organizational skills.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and applicable regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
• Interpret and translate federal, state, and contractual requirements into clear, actionable compliance guidance for business stakeholders.
• Develops and coordinates regulatory communications, including responses to inquiries, issue summaries, and disclosures.
• Supports the preparation, validation, and submission of regulatory reports, attestations, and filings.
• Proactively identifies compliance risks and evaluates business processes to assess exposure, provide risk stratification, and recommend mitigation strategies.
• Leads or supports issue identification, root cause analysis, and development of corrective action plans to ensure effective and compliant resolution of identified gaps.
• Provides subject matter expertise to audit and monitoring activities, including supporting audit scope development, testing strategies, and ongoing compliance oversight.
• Partners with internal and external stakeholders to support audit execution, regulatory reviews, and ongoing audit readiness activities.
• Evaluates remediation plans and validates corrective actions to ensure sustainable and compliant resolution of issues.
• Contributes to the development and delivery of compliance training, while mentoring stakeholders on regulatory requirements, policies, and best practices.
• Reviews and assesses policies, procedures, and business processes to ensure alignment with regulatory and contractual requirements and organizational standards.
• Leads or contributes to cross-functional initiatives to enhance compliance processes, drive operational efficiency, and align compliance activities with organizational objectives.
• Monitors regulatory developments and industry trends to identify emerging risks and support continuous improvement of compliance programs.
• Collaborates with compliance, legal, audit, and operational partners to ensure coordinated execution of compliance activities across business areas.

Skills

Communication skills

Analytical skills

Documentation skills

Time management

Regulatory knowledge

Education

Bachelor's degree or equivalent experience

Master's degree or JD preferred

Job description

Centene Corporation is seeking an experienced Medicare Compliance Advisory specialist to support day-to-day execution of the program in alignment with CMS requirements. The role acts as a subject matter expert, translating regulations into actionable guidance for business stakeholders and supporting audit readiness across operations.

The position requires 5+ years in compliance or risk management in regulated environments, with 4+ years in compliance advisory, and familiarity with Medicare